Active NPI
Jennifer Concannon, DAT, LAT, ATC
- Athletic Trainer
- Weymouth, MA
National Provider Identifier
1396253753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2448
- Practice address
- 65 Wilson Ave
Weymouth, MA 02188-3623 - Phone
- (978) 273-3620
- NPI assigned
- Jan 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 2448 | MA | |
| Athletic Trainer | 2255A2300X | 2448 | MA | Primary |
Addresses
Primary practice location
65 Wilson Ave
Weymouth, MA 02188-3623
Mailing address
65 Wilson Ave
Weymouth, MA 02188-3623
Phone (978) 273-3620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2448 | Other | MA | BOARD OF LICENSURE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2448 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640563200000",
"number": "1396253753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 WILSON AVE",
"city": "WEYMOUTH",
"state": "MA",
"postal_code": "021883623",
"telephone_number": "978-273-3620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 WILSON AVE",
"city": "WEYMOUTH",
"state": "MA",
"postal_code": "021883623",
"telephone_number": "978-273-3620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONCANNON",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "DAT, LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-18",
"last_updated": "2021-12-27",
"certification_date": "2021-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "207PS0010X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Sports Medicine",
"state": "MA",
"license": "2448",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "2448",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF LICENSURE",
"identifier": "2448",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Weymouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.